Obamacare will improve health care for homeless, study says

NEW HAVEN >> Obamacare will be a huge boon to homeless people and save the states money at the same time, according to a Yale study released Monday.

The health care law, the Affordable Care Act, will bring better and more coordinated health care to people who are homeless because more will be eligible for Medicaid. They may not be eligible now because, in addition to income limits, “you also had to have other problems,” such as a disability, or have expenses such as supporting children, according to Jack Tsai, assistant professor of psychiatry at the Yale School of Medicine and the study’s lead author.

Even among those eligible for Medicaid, the study found almost three-quarters were not enrolled. Fifty-three percent were uninsured or were covered only by state and local programs, according to the study.

Most of the health care law, the Affordable Care Act, goes into effect in 2014, in particular a provision in which anyone making up to 138 percent of the federal poverty level will be eligible for Medicaid, with no other requirements. The federal government is paying all of the cost for the additional patients. In Connecticut, the cost of Medicaid now is split between the state and the federal government.

Health care for homeless people now may be scattered among multiple providers or they may rely on hospital emergency rooms. Such scattershot health care tends to “take a toll on the medical system in other ways and cost the state in other ways,” said Tsai, a core investigator for the Veterans Affairs New England Mental Illness, Research, Education and Clinical Center. Under Medicaid, care for the homeless would be better coordinated.

Another way homeless people drain state funds is a higher rate of incarceration. “Studies have shown that the homeless get in trouble in order to get their basic needs met,” Tsai said.

Another positive effect of Obamacare for the homeless population will be mental health and substance abuse care. “Comprehensive health coverage can help fund some of the services of mental health (care),” Tsai said.

The study focused on information from 725 homeless people in 11 cities (none in Connecticut). Among recommendations were that states will need to reach out to homeless people to be sure they enroll in Medicaid.

Tsai noted governors in several states have opted out of the expanded Medicaid program “mostly down political lines. A lot of Republican states don’t want to participate in Medicaid because it’s part of the Affordable Care Act and it’s Obama’s thing … even though there’s a lot of evidence that they would save money.”

So far, 28 states plan to accept additional Medicaid money, he said.

The study said even in states that have requested expanded Medicaid funding aggressive outreach to the homeless will be needed to ensure they receive additional physical and mental health services and coordinated case management services required by the law.

The study appears in the September issue of the journal Health Affairs. Dr. Robert A. Rosenheck, professor of psychiatry at the Yale Medical School, is also one of the authors.